title: Respiratory and general outcome in neonates with renal oligohydramnios--a single-centre experience.
abstract: BACKGROUND
  Renal oligohydramnion (ROH) is predominantly caused by congenital abnormalities of the kidney and urogenital tract (CAKUT). Although the number of neonates born with chronic renal failure is small, they provide many challenges, and among the most problematic are respiratory management and long-term treatment of chronic renal failure. We studied the value of prenatal and perinatal variables to predict survival and the general long-term outcome of our ROH population. Method. A single-centre retrospective chart review was conducted in 36 neonates with ROH treated between 1996 and 2007. Respiratory data sets including minimum inspiratory oxygen concentration (FiO(2), 1d), best oxygenation index (BOI, 1d) and minimum arterial partial carbon dioxide (pCO(2), 1d) at the first day of life were available in 23 children requiring intubation.
  
  
  RESULTS
  ROH causes were obstructive uropathy (n = 19), polycystic kidney disease [autosomal recessive polycystic kidney disease (ARPKD) n = 5 and autosomal dominant polycystic kidney disease n = 1], renal agenesis/dysplasia (n = 10) and bilateral renal vein thrombosis (n = 1). Survival until discharge was 64% (23/36), and overall survival was 58% (21/36). Seven patients died within 48 h from respiratory failure. Non-survivors had a higher minimum FiO(2) and pCO(2) (1d) compared to survivors (P < 0.001). Mean BOI (1d) was 6.2 in survivors versus 43.9 in the non-surviving group (P < 0.001). Logistic regression showed that BOI (</≥ 9.6) and first diagnosis of ROH (≤/>28 gestational weeks) retained significance in predicting survival until discharge.
  
  
  CONCLUSIONS
  The attitude toward initiating dialysis in neonates is changing and long-term outcome in the absence of severe comorbidity is promising. Prenatal prediction concerning respiratory and renal outcome in fetuses with ROH is difficult. Our data suggest that BOI (1d) and onset of ROH may be reliable predictors of respiratory prognosis in children born with ROH.
authors.affiliation: Division of Neonatology and Paediatric Intensive Care Medicine, Children’s Hospital, University of Cologne, Cologne, Germany. katrin.mehler@uk-koeln.de
authors.forename: Katrin
authors.initials: K
authors.lastname: Mehler
authors.forename: Bodo B
authors.initials: BB
authors.lastname: Beck
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kaul
authors.forename: Gohar
authors.initials: G
authors.lastname: Rahimi
authors.forename: Bernd
authors.initials: B
authors.lastname: Hoppe
authors.forename: Angela
authors.initials: A
authors.lastname: Kribs
mesh_terms: D000013:Congenital Abnormalities / Q000209:etiology / Q000401:mortality*; D005260:Female; D005333:Fetus / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000151:congenital / Q000209:etiology / Q000401:mortality*; D008297:Male; D016104:Oligohydramnios / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000401:mortality*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate